Provider Demographics
NPI:1093730368
Name:BROWN, GERALD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 W 5600 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2470
Mailing Address - Country:US
Mailing Address - Phone:801-776-2806
Mailing Address - Fax:801-776-5405
Practice Address - Street 1:1952 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2470
Practice Address - Country:US
Practice Address - Phone:801-776-2806
Practice Address - Fax:801-776-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139436-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice